Medical billing and coding is increasingly viewed as one of the most desirable medical support careers as well as one in incredibly high demand. It is considered among the nation's most rapidly growing occupations. The primary rules of medical billing and coding specialists are to secure and guarantee payment for medical services. Medical billing and coding specialists oversee the flow of medical records and patient records accurately, collect data and monitor/document information between patients, providers and third-party payers as well as insurance providers, patient family members and more. Medical billing and coding personnel ensure the proper function of all healthcare establishments.
Medical coding entails working to assign each medical service a specific numeric code. Each code represents a different outlet of medical practice including diagnostic services, procedures and treatment. As a medical coder, one must document and enter data into the medical institutions database through use of medical coding and applied protocol in order to create a statement, medical invoice or claim.
In turn, medical billing entails acting as the middleman and messenger between a medical facilities staff and paying parties. In the scenario of payment refusal, confusion overbilling or issues involving claims, medical billing staff must work to investigate and evaluate each claim, articulate and explain information, verify necessary information, pass on messages and enter updated information into the facilities’ database.
There is a great deal of overlap between the two roles, billing and coding, especially in smaller medical practices. Depending on whether or not an institution separates billing and coding staff will provide separate positions for those designated roles, employee responsibilities are compiled or divided accordingly. Medical billing and coding specialists may also be asked to handle matters of insurance fraud or debt collection.
For the most part, medical billing and coding specialists perform the following duties:
• careful review of medical procedures that have been documented by physicians
• transferring data from medical procedures to codes which in turn can be translated by additional medical coders, medical personnel and physicians, payers and other medical facilities
• sending patient information codes including treatment codes to payers or other necessary parties
• collaborating with and communicating with physicians, care providers and insurance reimbursement personnel on billing
• overseeing all patient billing
If a certain job within the field of medical billing and coding involves a split of work obligations between multiple individuals, depending on the healthcare sector one is working for, employment duties will be more specific. In turn, the amount of job turnover and schedule flexibility will differ.
In the case of a facility in which medical billing and coding duties are divided between multiple individuals, the job of a medical coder becomes solely translating information on patient conditions and physician treatment plans into what is known as universal medical coding to send to be responsible parties.
A medical coder will:
• analyze patient records
• follow common procedure terminology (CPT) codes in order to enter treatment information
• speak with those involved in medical billing to maintain standards of accuracy for received treatment codes
A medical builder will:
• handle and receive medical codes regarding patient treatment and use them to assemble invoices, claims, bills and establish records
• interpret CPT codes in order to coordinate any reimbursements and claims for third-party payers
• communicate with insurance companies as well as patients to provide clear and adequate notice regarding billing or payment
• ensure the coordination of reimbursement with payers
• bill patients for medical procedures, services and visits
What to Expect
The work environment medical billing and coding employees can expect work to usually take place in hospitals, specialty clinics, nursing outpatient facilities, physician practices, insurance provider offices, home care facilities, doctors offices, nursing or care homes or medical research facilities.
Those who work within the specialty of medical billing and coding usually have administrative office settings including telephone, computer, bookkeeping and documentation methods handy and filing through a mix of physical and electronic paperwork. Unlike most employees within the healthcare profession, medical billing and coding specialists usually have very little contact with patients. While it may be necessary to maintain communication via phone calls, emails, faxes or in person consultation, medical billing and coding personnel work far more closely with physicians, providers, insurance carriers and fellow staff members to gather billing information, coding information and the resources necessary to prepare patient paperwork. Occasionally, such specialists may have the opportunity to work from home depending on how much information can be collected and processed outside of a physical office of practice.